by Laura Dana, LCCE, CD (DONA), CAPD
When the pains in her abdomen made her sit up suddenly out of a deep sleep, she never realized that today would be a day different from the rest. She left her job and took the afternoon off because of the trip to the to see the OB/Gyn,, but planned like every day, to return in the morning.
However, that was not going to be the case this time around. During the visit with her physician, she was told that not only was her cervix changing, but also it was "dangerously" close to opening. Bedrest was going to be the prescription and she was going to have to remain in bed, only up for trips to the bathroom and to get something to eat, and that was it.
All traveling would have to be suspended, invitations would have to be declined, and shopping trips would have to be done without her. She was going to have to sit this pregnancy out, like a football player injured during the big game. And this had to be the way because she was only 26 weeks along and not ready to deliver the baby growing inside her.
It sounds like a script from a movie, but bedrest is how many women land up spending part of their pregnancy. The story does not end at the time the bedresting begins, just the opposite, it continues on while changing the pregnancy's course completely. Bedrest during a pregnancy can vary from "pull back your hours at work" to being admitted to the hospital, bladder catheterized, Magnesium sulfate being pumped into your veins, and having your bed put in a Trendelenberg position.
It is a very subjective term and can even change over the course of time to become more strict or lifted completely. Although, however subjective it is physically, the one constant is the havoc it can play with the emotional aspect of pregnancy.
For many women, bedrest is where they stay until they either go into labor naturally, are induced, or schedule their Cesarean section. Depending during which week of pregnancy bedrest occurs, they might or might not be able to attend childbirth classes or finish them, they might or might not qualify for disability from personal insurance plans, they might or might not lose their income -- and that doesn't even take into account the women who bedrest while having small children at home. It usually comes at an inopportune time in one's life regardless of the circumstances.
I commonly hear "I wish I had been given bedrest during my pregnancy. I could have used the sleep." It's a nice thought in theory, but being in bed does not necessarily provide a woman with any more sleep than she would normally get. In fact, it can negatively affect the amount of sleep because her internal clock can be readjusted by not moving around constantly.
That inactivity can reduce the amount of blood flow in her body and can impact her body's muscles to respond appropriately. She may find that her feet up to her hips are sore from "sitting around" and that joints may pop and crack more than normal. Getting good blood flow to her lower extremities is important in keeping any muscle atrophy to a minimum.
Emotionally, on the other hand, not having a pregnancy that is physically fit can lead her to believe that she is unlucky and those feelings only work to destroy her energy level.
Loneliness also can certainly affect a pregnant woman's feelings about her pregnancy. When she is isolated by being in bed during what is supposed to be the "happiest time of her life," she can feel inadequate, like she has done something wrong, like she has been robbed of something that other women take for granted.
It is important for the people who she surrounds herself with to keep positive thoughts and supportive words coming her way, that they treat her like she is doing her utmost to care for herself and her baby, and that they not dwell on the negative aspects of bedrest, but find the bedresting mom ways to occupy her time in a positive way.
Locating books dealing with bedrest can help mom to know that she is not alone. They can help give her ideas of things that she can accomplish even though she is relegated to bed. They can give her daily affirmations that continually uplift her spirits and tell her that she is special and worthwhile. They can also provide her with entertainment over the course of the day. All types of books are good and it should be mom's choice as to their content. Having mom write a weekly email to her friends and family about her situation can not only help to unburden her of possible loneliness, but also keep those interested in touch with her situation as it changes over time. Since mom has so much time to herself to think, it is really up to her to "enlighten" those who do not understand.
There are underlying feelings of inadequacy that she might be dealing with, however. The guilty feeling that she should have done something more, less, different; the disappointed feeling that she should be more in control of her own body; the unexpected feeling of being different than most pregnant women is all consuming if left without anyone to dispute them. These emotions can become very overwhelming and it is important for her to discuss them with her physician, her partner, or whomever she prefers is very important in letting her get things off her chest.
She might need counseling to deal with her feelings, but definitely needs a venue through which she can express those feelings openly and honestly. Helping her to find support groups for bedresting women can lead her down a better mental path and talking to other women who have gone through similar circumstances can allow her to understand that she is not alone.
Usually with topics such as this, we only concern ourselves with the mom, but dad can be emotionally impacted by a pregnancy changed by bedrest, as well. Not only does mom's health status become something that dad has to deal with, but normally being used to sharing all the responsibilities of their life together and then being told that you are going to have to fly solo while providing constant positive reinforcement to mom, can be a daunting task for anyone, especially for the partner. Dads in a bedresting pregnancy are many times pushed to the side and their feelings and concerns are typically not addressed. Mom is usually too overwhelmed with her own feelings and society is not accepting of a man who needs to "unload" and talk. So in many cases, dad is left to handling his own emotions by himself and just like mom, can become very lonely.
I recall being on my own bedrest and how much more tired my husband began to look as our pregnancy progressed. While I was dealing with my own issues, my husband was taking care of the house, going to work, making all the meals, handling our families, and his most important job, taking care of me. His own health was never called into question even though he was not getting enough sleep and was wearing down as the weeks passed by.
Once I was admitted to the Antepartum unit of the hospital, his days became much longer and tiring. They would start at 5 am when he got up for work and continue until around midnight. Once he finished work, he had to go home, take a shower and clean up, answer all my email, print up letters to bring to the hospital, gather the mail together, feed the dog, and get back into his car to come up to the hospital and share some time with me. He would usually stay until about 9:30-10:00 pm and then he would return home, eat some dinner, and go to bed, only to start that whole routine again each morning.
After 17 weeks of my having been in bed for the bulk of the pregnancy, my husband was exhausted. When our sons were born at 31 weeks, and remained in the hospital for another 5 weeks, my husband had another 5 weeks to pull long days that were emotionally draining, except once they were born, he had to worry all day about the health of his preterm twin sons.
Once my own health was not an issue, I was able to somewhat take some of the emotional burden from his shoulders, but no one ever asked him how "he" was feeling about everything or how "he" was dealing with such an emotional time in his life.
Another issue that bedrest may bring to light is a feeling of grief. For a woman who intended to do her best in maintaining a healthy pregnancy, participating in every aspect, and enjoying all the new sites and sounds that a pregnancy can bring to a person, finding out that bedrest is part of the formula can be the start of a grieving period.
Bedresting women will many times go through all the same stages of grief that a person goes through when dealing with death. Dr. Elisabeth Kubler-Ross describes those stages as: denial, anger, bargaining, depression and acceptance. Denial can be described as the shock of finding out that this pregnancy is not "normal", that there are complications. A feeling of unreality occurs and during those first few days, a sense of being out of touch can be released. This can be a real emotional release and insomnia, mood swings, and crying spells can come on suddenly, just like in early pregnancy.
There can also be a sense of panic that things are going wrong and that the pregnancy is off course. As the "anger" phase comes on, this is where the woman can question her own body, her belief in Nature or God, and the care she might be receiving from her medical caregiver.
For a woman entering the "bargaining" phase, she might have discussions with her physician/midwife to withdraw the bedrest prescription, to ease up on restrictions. She might make promises to her higher power to be a good mom if only she is able to continue her pregnancy without any further problems. Depression, as expressed earlier, can become an overwhelming feeling, but if handled properly, the pregnant bedresting mom can move into "acceptance" and come to understand that she IS doing what Nature needs for her to do -- she is providing a safe and healthy environment for her baby, but in a different way from most moms.
Once she reaches this acceptance that she can only do what she can do, the grief experience in bedrest can be understood and dealt with. Although just as each individual dealing with bedrest is different, so is her path toward acceptance. She can make short-term goals, plans for the future, and learn that with each day she spends on bedrest, she is one step closer to a healthy outcome for both her baby and herself. She can use her emotional stress to move forward in her life. It is important for bedresting moms to "connect" with their babies as much as possible and to spend quiet time just listening to the signals being sent by that baby.
In the end, it is not important where we spend our pregnancy, but how we spend our pregnancy. The emotional issues that each pregnant woman/couple deals with can be exaggerated when she spends even just a little part of that pregnancy in bed. Coping with things as they come and playing the game is much easier when one understands that the rules can change at any moment. Thinking positively and remaining focused on a healthy outcome is key in handling the emotional challenges of a bedresting pregnancy.
Laura Dana, LCCE, CD(DONA), CAPD is a mother of twin boys born prematurely, a Lamaze childbirth educator, DONA certified labor doula, and a CAPPA certified Antepartum doula, specializing in high risk and multiple birth pregnancies. She and her doula partner, Maggie McCarthy, have a company in Orlando, Florida called Birth Options: Education and Doula Services.
Copyright © Laura Dana. Permission to republish granted to Pregnancy.org, LLC.